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Smitirupa Mishra: Deep Insights Into Neutrophil Morphology
Smitirupa Mishra/LinkedIn
May 8, 2026, 14:53

Smitirupa Mishra: Deep Insights Into Neutrophil Morphology

Smitirupa Mishra, Consultant Pathologist at Sparsh Hospitals and Lab Head at Pathkind Labs, shared a post on LinkedIn:

“Most often, we report ‘Total leukocytosis with absolute neutrophilia’ and move on.

But somewhere between automation flags, differential counts, and busy sign-outs, we forget to actually look at the neutrophils.

Neutrophil morphology is not just a decorative finding in the peripheral smear – it is a clinical conversation happening under the microscope.

Toxic granulation, Döhle bodies, cytoplasmic vacuoles, toxic vacuolation, hypogranulation, hypersegmentation, Pelger-Huët forms, giant bands, apoptotic neutrophils – each pattern tells a story.

A neutrophil can quietly hint at:

  • Severe bacterial sepsis
  • Cytokine storm
  • Marrow stress
  • Drug effect
  • MDS
  • Vitamin deficiencies
  • Congenital anomalies
  • Hidden inflammatory states

Automation can count neutrophils.

Only morphology can reveal what they are going through.

Sometimes the diagnosis is not in the CBC numbers.

It is in the attitude of the neutrophil.

The peripheral smear is still one of the most underrated ‘clinical photographs’ in medicine.”

Smitirupa Mishra

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